Oh the places you’ll go

It is hard to be a Neonatologist who took the path through Pediatrics first and not use a Dr. Seuss quote from time to time.  e26a79ea-90a6-4d2c-b748-107583da3b3a_1-c8a62a7c18ba4bbc0bcfb40c1c3e4d16.jpegIf your unit is anything like ours where you work I imagine you feel as if you are bursting at the seams.  As the population grows so do our patient volumes.  I often quote the number 10% as being the number of patients we see out of all deliveries each year in our units.  When I am asked why our numbers are so high I counter that the answer is simple.  For every extra 100 births we get 10 admissions. It is easy though to get lost in the chaos of managing a unit in such busy times and not take a moment to look back and see how far we have come.  What did life look like 30 years ago or 25 years ago?  In Winnipeg, we are preparing to make a big move into a beautiful new facility in 2018. This will see us unify three units into one which is no easy task but will mean a capacity of 60 beds compared to the 55 operational beds we have at the moment.

In 2017 we are routinely resuscitating infants as young as 23 weeks and now with weights under 500g at times.  Whereas in the past anyone under 1000g was considered quite high risk, now the anticipated survival for a 28 week infant at 1000g is at or above 95%.  Even in my short career which began in 1998 in terms of Pediatrics and then 2001 in Neonatology our approach in terms of comfort with the smallest infants has eased greatly.  What inspired this post though was a series of newspaper clippings from 1986 and 1991 that made me take a moment to look up at the sky and mutter “huh”.  When you take a trip down memory lane and read these posts I think you will agree we have come a LONG way and (in truth) in a very short time.

1986 – Opening of the New NICU at Children’s Hospital

Newspaper clipping

This unit was built with 3.5 million dollars.  Imagine how far that would go now…

The unit had a capacity of 18 beds but opened with only 12 and a nursing staff of 60 (compare that to 150 now!).  They couldn’t open more beds due to the lack of available nurses with sufficient skills.

My favourite comment to provide some perspective was that 5 to 10 years before this time the estimated survival for infants under 1000g was 15%!

Have we ever come a long way in family centred care.  Can you imagine having a baby born now at 695g whose family wouldn’t get to hold them till almost 3.5 months of age?!  That is what happened in the case described in this article.

1991 – Opening of the new Intermediate Care Nursery

Chronicle page 1Chronicle page 2

Did you know the old unit had 19 beds (was originally 9 babies) and expanded to 27 at this time?

It cost 3.1 million to build this unit.

The long and the short of it is that yes things are busy and in fact busier than they have ever been.  Do not lose sight however wherever your practice is that you are part of a story for the ages.  Things that were once thought impossible or miracles are now everyday events and you have been part of it.  For those of you who read this post this will likely bring about a lot of nostalgia for you.  Thirty years in medicine is not a long time and we have accomplished so much along the way.  For those of you who are just starting out, imagine where we will be in 30 years from now.  I for one can’t wait to read about it and wonder where we will have gone by then.

 

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5 thoughts on “Oh the places you’ll go

  1. Love your blog and share your posts frequently with colleagues. This one took me down memory lane as well as I mirror your training time frame. Rather amazing to think about what we used to do “back in the day” and how the line of viability has moved lower and lower. This post made me pause and think about what I have seen happen over the course of my career thus far.

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  2. I can top the lot of you. I’ve been working with neonates since 1972. We had no CPAP, no phototherapy, no ultrasound, hardly any ventilators, no blood gas analyser outside the path lab, no surfactant. We had vast numbers of pneumothoraces. We had vast numbers of deaths, for that matter. We didn’t understand parent-infant bonding, so we banned parents from the unit in the interests of infection control. Babies hardly ever survived before 28 weeks, and those that did were terribly damaged. There was very little research around – in our speciality, anyway – everyone seemed to be pretty much flying blind, and that’s one of the most memorable things for me. We’ve done an amazing job in creating this speciality, but to me the most sobering thing is to remember the terrible things that we once accepted out of ignorance – like operating on babies without anaesthetic. Never forget how wrong you’re capable of being!!

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